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The Choking Game: Facts for Parents and Teachers
Teenage boy

Download "The Choking Game" fact sheet (pdf)

What is the “choking game?”

The “choking game” is a strangulation activity that some youth may participate in to achieve a “high-like" sensation. It involves cutting off circulation to the carotid artery with a rope, belt, hands, or holding your breath. It may occur alone or in groups. The choking game is different from autoerotic asphyxiation (AEA), which has a sexual component and is almost always done alone.

The choking game is also known as the pass-out game, fainting game, blackout, knock out or flatline game.

Signs and symptoms

It can be hard to identify. There might not be any signs of past participation. However, there are some physical, behavioral and environmental signs that could indicate a youth has participated.


Physical signs

  • Bloodshot eyes
  • Unexplained marks on the neck
  • Small red dots around the face, eyelids, or the lining of the eyelids and eyes
  • Frequent, severe headaches
  • Disorientation after spending time alone


Behavioral signs

  • Discussion or mention of the activity or its aliases
  • Wearing high-necked shirts, even in warm weather


Environmental signs

  • Unexplained presence of dog leashes, choke collars, bungee cords, ropes, scarves or belts tied to bedroom furniture or doorknobs or found knotted on the floor


Who participates in this?

Any youth could be susceptible to participating. They may believe it is safe and fun. They may have participated before without anything bad happening.


About 6% of eighth-graders and 7.5% of 11th-graders say they have participated in the choking game. This translates to approximately 5,200 eighth and 11th grade students in Oregon. Among those who have participated, one in five, or about 450 eighth graders, have done so more than five times. These youth are exposed to an even greater risk of injury, especially if they participate alone.


Generally, males and females participate at the same rate. However, black males and Pacific Islander males and females may be participating at a higher rate than white youth.


What can parents, teachers and other caring adults do?


Talk to youth. Find out what is going on in their lives. Other behaviors, such as sexual activity, alcohol and drug use, poor nutrition and exposure to violence were found to predict participation in the choking game. You may want to involve a health or mental health professional for more assistance.


Risk-taking is a normal and important part of growing up. Encourage healthy alternatives that youth might enjoy. These activities could be physical, social, community-oriented or creative. Some examples are:

  • Snowboarding, rock climbing or martial arts
  • Participating in art, music, theater or dance
  • Taking a class you enjoy or learning a new hobby with friends
  • Volunteering in the community or working with younger kids


Parents, make sure your youth has had a checkup (well visit) in the past year, including a comprehensive risk assessment, which can help identify important health and mental health issues.

Important messages to share with youth

  • If you know someone who is doing this, you should tell a trusted adult. It is not safe.
  • This is a dangerous activity that could be harmful to you or your friends. Some youth have done this and suffered injury, brain damage or death.


Resources and more information